Most dislocations have an associated injury to capsuloligamentous stabilizers that progresses from lateral to medial, with the anterior band of medial collateral ligamental (MCL )being the last to be injured and is most often intact after injury (exceptions: trans-olecranon fracture dislocations, coronoid fractures)

Classify according to the direction of displacement of ulna relative to humerus

Posterior, posterolateral, posteromedial, lateral, medial, anterior

ED Management:

Parvin’s (A) and Meyn & Quigley (B) Reduction Techniques (Egol 2010)

Emergent orthopedic consult for any patient with concern for vascular damage (loss of pulse), neurological deficits (loss of sensation, contractures) or open dislocation/fracture

Simple Dislocation

Closed reduction: correction of medial or lateral displacement followed by longitudinal traction and flexion

Parvin’s method: patient lies prone with entire upper extremity hanging off the bed, downward traction is applied to the wrist for a few minutes—> olecranon slips distally, arm is then lifted gently (Method A)

If persistently unstable after reduction, splint, obtain repeat radiogrpahs to ensure elbow joint and fractures (if any) are in stable position and will need immediate orthopedics followup in the next 3-5 days for repeat radiographs and will likely need a more pronlonged immobilization course with splinting for 2-3 weeks and a hinged splint for up to 4 weeks (Ahmed 2015)

Complex Dislocations:

Most will need operative management, however, reduction and splinting may be definitive management for patients with minimally or non-displaced radial head fracture

Patients who elect for non-op management must be made aware of potential for instability of joint and future restriction of range of motion

Prognosis:

Recurrent dislocations are uncommon (incidence is increased when terrible triad is present)